Custom Search

Aug 8, 2008

Speech "The New Frontiers Of Harm Reduction" AIDS Mexico 2008

Nothing about us without us, The New Frontiers of Harm Reduction

Stijn Goossens, Belgium

Click here for the session slides

Full Video - The New Frontiers of Harm Reduction
(Stijn's presentation starts at the 41st minute of the video)

  • HR2 - Harm reduction and human rights, Rick Lines, United Kingdom

  • Young people taking the lead, Caitlin Padgett, Canada

  • HIV and drug use (including alcohol) in Africa, Olanrewaju Onigbogi, Nigeria

  • Nothing about us without us, The New Frontiers of Harm Reduction, Stijn Goossens, Belgium

  • HIV and non-injecting drug use in Latin America, Graciela Touze, Argentina

Good day to all of you.

It’s wonderful that the organizers of this year World AIDS Conference have included so many harm reduction and DU related events in the program.

It is also wonderful that a DU is invited to speak at the New Frontiers of HR session.

Unfortunately - it’s already not that wonderful that I / the DUA have to speak again on “Nothing About Us Without Us”. Since the IHRA’s IHRC’2006 held in Vancouver, where VANDU (the local DUO) presented first this small- but very true - booklet, it seems that wherever there is a HR event a DUA is invited to speak on “Nothing About Us Without Us”.

Nevertheless, if we look what happens in practice we’ll see that nothing has changed that much since Vancouver. DU – insist to be included; the professionals – acknowledge that our partnership is crucially needed, but apart from some very local or very isolated examples – no real cooperation have ever been achieved.

Therefore, this time I’ll not repeat again WHY DU Should be involved in everything About Us. Apparently – either for real or for show off – everyone agree here. Our main concern and I mean my peers and my own main concern is can we Ever Achieve a Real Cooperation?

I say this because the general way DUA are addressed and treated drives them away from DUA.

With all my respect and admiration to everybody in this room and everybody world-wide who is striving for real harm reduction, I’ll try to present truly my – DU point of view – on how I feel about DU Activism, WHY the best of our peers lose their flame, and HOW to keep them involved. I mean no insult to anyone. Just “Nothing about Us without Us” can never be if there are no DUA with experience and expertise left around.

To be able to make it more clear that We Really Do Lose Our Best DUA and also – to make it more clear Why They Go Away – I start from the very bottom-line, or – from the most basic and fundamental position, which in our case - I believe - is the differences in the understanding of :


Let’s before speaking about cooperation agree upon who we (the DUA) will cooperate with? About what? And mainly – Where Harm Reduction Ends And Turns Into Something That No Real DUA Will Cooperate For.

I’ll repeat once again- I mean no insult to anyone. It’s not me. It’s the brutal reality my peers and me are forced to accept daily. And please – trust me that I have plenty of reasons to make all these statements you read behind me.

Still, being a DU - or not that trustworthy by default - I’ll also give prove, so everyone could have a better trust in me and in my position.

If we just open the official web page of one well-known Harm Reduction organization on the most central place, under the title What Is Harm Reduction we read:

The major consequences of drug use are:

  • Transmission of blood borne diseases such as HIV/AIDS and Hepatitis B and C

  • Overdose

  • Various medical and psychological conditions, etc., etc. and there are some more of these.

So as I’ve appointed DUA find these consequences and all of the other consequences included in the quoted web page to be consequences of Prohibition, not consequences of Drug Use. It’s even not mentioned – consequences of Illegal Drug Use.

From another hand – the three UN Drugs convections, including the last one – about the Drug Free World achieved by Prohibition – obviously are the harm reduction measures of our society when DU opinion is not taken into consideration. That’s why we insist ‘Nothing About Us Without Us”.

That’s why also we lose our best DUA. The difference between Harm reduction and Prohibition is so small that we (DUA) after some time get confused what we work for, who we work with and from this moment on it’s very difficult for us to remain involved as activists.

To make it more clear again I’ll go back to the quoted web-site of the same partner-organization.

At the very same page there are 5 principle of HR appointed. The 1st is that wrong that I have to make a training to explain it. Without going too deep in the concept of Harm reduction I may say that in any case my (DU) basic need is not achieving abstinence in some future moment. This is neither the first principle of HR, nor - an appropriate perception to approach and cooperate with DUA. Even more- such starting position will never result in effective, user-friendly, client-centered harm reduction services.

Principle 2 is just partially wrong. It says: A hierarchy of risks must be established to avoid HIV infection from drug use.

I say that it’s partially wrong, because nowhere in the whole web-site there is no indication that harm reduction may refer to something else apart from preventing HIV and other blood transmitted infections. Actually Harm Reduction is much more. Harm reduction is not limited to one of the consequences of Prohibition. It covers all consequences and does not exclude any of the available options – even drug free is good enough when drug free comes as a result of personal voluntarily decision.

Anything that complies with human rights and is acknowledged by the local DU community as helpful, as useful, as working is harm reduction. And by local DU Community I mean – the community where the measures or the harm reduction programs are implemented.

Harm Reduction is not for sale! What works in Belgium does not necessarily work in Russia or elsewhere. Each community has its own problems that cause harms to both – the local DU and the local public.

Therefore, if we want to implement real harm reduction programs, the very first step should be – go deep down in the DU Community and check what is needed. That’s why we insist ‘Nothing About Us Without Us”.

And because no one actually listens to us – the people who use drugs- currently what we see in practice is:

In Belgium Harm Reduction is studied by criminologist. So far about Belgium and about the Harm reduction services in Belgium.

The best argument the professionals world-wide have pro harm reduction is : Cost Effective.

I really do not know how we -the DUA should feel about cost effective. Our peers – the previous generation DUA started what we nowadays call harm reduction with the sole goal – to save lives. Back then harm reduction belonged to DU Community and its cost-effectiveness came along implicitly.

Nowadays when harm reduction is monopolized by harm reduction professionals, when millions are spent on harm reduction projects, some of which – with questionable results, others – named Drug Free. And everything is so institutionalized that DU have to remind constantly that the main harm here is caused inside our community and by our community. I do not know how to feel about the cost-effectiveness of harm reduction.

I also do not know how to feel about harm reduction itself, if the people who do harm reduction today define it as – I quote: “a concept with alternative approaches that aim to keep drug users alive, healthy and productive until drug treatment works or until they grow out of drug use”. In any case - if our productiveness is calculated in the cost-effectiveness – we don’t like the cost-effectiveness that much anymore.

All around the world DU are stigmatized, discriminated, marginalized, and criminalized. We are also sick, isolated, homeless, detained in concentration camps! And .... WE have to be productive!

Under these conditions we do not want to be productive!!! And when addressed like this – we do not want to be cooperative!!!

That’s why today I changed the approach. Instead of explaining one more time WHY “Nothing About Us Without Us” I put the focus on HOW.

And if I quote all the time one and the same organization it is not to point finger. If you allow me I’ll even not name it. As I said – I do not want to insult anyone. I just want to make it more clear: what we – DUA - encounter daily. If I go to other web-sites of other acknowledged DU partners I’ll encounter for sure the same attitude. The reason to quote one and the same organization is to leave no room for misinterpretations of what I say.

I want to be absolutely clear that I do not make a compilation of the worst experiences my peers and I have ever had. For us – what you hear now is a routine. So at the current stage of cooperation we and our service providers have achieved, there are just few other things I want to add before I finish.

The most important is:

Do not do it without us. The practice show that it does not work. And all mistakes cost human lives. And if you want to do it in the right way, please, do not forget to approach in the right way, which means respect us as equal partners. My experience shows that the way we are approached is the main reason that makes the cooperation with DUA so difficult.

To clarify respect and equal partnership I have included three more pointers:

Don’t take DUA involvement for granted, or obligatory for us. We also have our bills. Pay us. I think here everything should be clear. We are far above the age of enthusiastic teen-agers. We might believe in what we do, but we have to survive. Most of us have families to support.

Our job is too exhausting to do it as a side hobby and meanwhile – to make our living as full time employees elsewhere. It just doesn’t work like this. There is no such hobby - activism. Being a DUA totally drains us. So having an airplane ticket and a hotel room for free from time to time is not good enough. Not that we are greedy. As I said – we have to survive to be available – like it goes with drug free: First - keep us alive.

Also - Do not think that we are the beneficiaries. Society wins. Motivate us. Don’t confuse payment with motivation. Being a DUA is neither easy, nor - pleasant, nor – a well paid job. Sooner or later even the most devoted of us start asking themselves why they have to take all that comes along with the job, if nothing seems to make a difference. Please, reconsider what motivation we have to do what we are expected and why should we undertake anything. Try for a moment to look from our point of view.

And once again - revise your approach and the offered motivation. Take into consideration our personality and individuality. WE ARE AVTIVISTS! Here we come again to the main issue we have: respect. If there was respect in our relations, everything else I said about payment, motivation would be unnecessary details.

If our professionals really respected us they would never address us in the way they do it now. Happily, although exceptions, we have real partners. I just would wish that our real partners become the majority.

What else I can say. If this is a session about the new frontiers of harm reduction and I’m suppose to speak on Nothing About Us Without Us, probably I have to make a comment on our – DU view on the new frontiers. But before appointing the new frontiers, let see where we stand now:


International level - promote the best practices worldwide

Local level – advocate for more harm reduction programs that address the needs of the local DU Community. Free, affordable and equal access to these programs

Cocaine and all other stimulants of amphetamine type: Start from the very beginning – RESERCH! And again: Implement HR programs based on the needs. This means Needs ASSESSMENT, not – political decisions, based on judgmental moralism or moralistic judgments. We do not need moralism – a little bit pragmatism will do better.

And, of course, under the conditions of Prohibition there will always be a black market of illegal substances that are potentially harmful.

Harm Reduction is not a constant, it’s a dynamic variable. The need for new harm reduction services does not end with concrete substances. There'll always be new drugs, new research will always be needed and new DUA who can tell you best about the new drugs.

So, if you – our professionals – prioritize what I just summarized up to now, Harm Reduction will be brought back to the right perspective from the times of its starting point. This would be one good new frontier.

For us – DUA – we will keep on insisting for more and better HR services, but we already put our new frontiers a little bit ahead. Through the approach of harm reduction we can address only the violation of our fundamental human right to health and proper medical services.

Unfortunately – the zero tolerance approach towards the DUs had unforeseeable in scale and unimaginable in cruelty practical results.

There are places where nowadays the concentration camps are called treatment facilities. And unfortunately we have our reasons to think that the future policies will allow increased options for health approach coming along with increased possibilities for repressions.

So – we’ll never turn our back on harm reduction but our new frontiers will be the approach of human rights in general. We have 30 fundamental human rights. In one way or another all of them are violated by the interpretations and the practical implementation of the UN Drug Conventions. We’ll use all possible legal means to stop the massive abuse of DU human rights world-wide.

Stijn Goossens

Drug User Activist


Aug 6, 2008

People Who Drugs Living With and Affected by HIV; Key Policy and Service Advocacy Issues

World Aids Conference 2008
People Who Drugs - Living with and Affected by HIV

Key Advocacy Statements

The key advocacy messages were drafted by a group of DU-Activists during the HIV+ DU affiliated event on Saturday August 2, 2008.

A core group of DU-Activists (Erin O'Mara (UK), Prem Limbu (Nepal), Jason Farrell (USA) and Stijn Goossens (Belgium) edited the draft statements and wrote accompanying background paragraphs per key advocacy issue.


  1. Allocation of resources proportionate to incidence of drug use, prevalence and vulnerability to HIV

  1. Removal of legal and policy barriers that limit access to quality harm reduction and HIV treatment, prevention and care services

  1. Greater involvement of people who use drugs at all levels and stages of HIV and drug policy design and implementation


  1. Universal review of national practices and the implementation of standards in the field of substance use and HIV related services

  1. To prioritize the needs of HIV+ women who use drugs

  1. The need to broaden and develop comprehensive and inclusive services that consider the changes in modalities in current drug using behaviors and drug culture

  1. To make accessible best practice health and harm reduction services within prisons and detention facilities including HIV prevention and treatment

People Who Drugs - Living with and Affected by HIV

World Aids Conference 2008

Key Statements

On Policy:

  1. Allocation of resources must be proportionate to incidence of drug use, prevalence and vulnerability to HIV ”

There is a serious misallocation of resources: according to UNAIDS, less than 0.5% of the USD 8.1 billion earmarked for the global AIDS response in 2006 was invested in harm reduction. Considering that 30% of new HIV cases are detected among injecting drug users outside Sub-Sahara Africa, there is a clear imbalance in resource allocation that must be urgently addressed in order to curb HIV transmission. In addition, overwhelming evidence indicates that harm reduction programmes are effective, safe and cost-effective and yet those programmes are underfunded, under-supported and often marginalized among the donor community. Ignoring people who use drugs and denying them services will lead to negative consequences and Universal Access goals and the Millennium Development Goals are unlikely to be met.

  1. Removal of legal and policy barriers that limit access to quality harm reduction and HIV treatment, prevention and care services

We understand that the UN Secretary General has already noted in his addresses this year a need for the removal of policy barriers to effective prevention, treatment and care for people who use drugs and we are extremely grateful for this support. Yet more must be done. Policy harmonization within national governments must be a priority – too often drug control policies are in direct conflict with both harm reduction and HIV policies and commitments made on HIV are not taken into consideration when drug control legislation and policies are developed. Law enforcement continues to be a major barrier to the implementation of services in almost all nation states.

  1. 3) Greater involvement of people who use drugs at all levels and stages of HIV and drug policy design and implementation

Today, people who use drugs now represent a significant proportion of the people who contract HIV/HCV yet their involvement in public health campaigns and substance related services are minimal. Just like the GIPA principles tell us, the global response to HIV and drugs must include people who use drugs and provide safe spaces for their meaningful involvement and participation. Yet drug users are generally left out of discussions and are not consulted on the policies that directly affect their lives and livelihoods. Furthermore, governments and community based HIV/AIDS organizations CANNOT claim they involve HIV positive people in their work on HIV/AIDS without actively and meaningfully involving drug users living with HIV in all levels of policy making and service design. This includes service development, provision, implementation, monitoring and the evaluation of a nation’s drug and HIV services. We urge nations to abide by the UN AIDS publications which note that the participation of people living with, and vulnerable to, HIV – which includes drug users – in programme and decision making is a matter not just for human rights and ethics but of ‘best practice’ for effective programmes.It is therefore essential that UN agencies and all stakeholders demonstrate leadership in terms of involving people who use drugs and acknowledge their role as key stakeholders in the global fight against HIV/AIDSs

On Services


  1. Universal review of national practices and the implementation of standards in the field of drug treatment.

Too many governments have not taken drug treatment obligations seriously as a matter of a right to health. There are an alarming number of abuses and human rights violations occurring in the name of drug treatment, often affecting the most vulnerable, in particular those who are doubly stigmatized through drug use and HIV\HCV infection.

Therefore we urge UNAIDs/WHO to commission a global review of national practices and standards in the field of addiction treatment and drug\alcohol services, with an additional focus on the HIV positive drug using population. This must be part of a process to develop a universal human rights based set of standards and requirements for drug services and treatment programmes - as well as the establishment of mechanisms for monitoring the compliance of nation states. In addition, we would urge UN/WHO/ UNDOC when developing these standards to identify what is NOT considered acceptable or ethical as drug treatment

We support the evidence which states that the most effective substance related services are-

  • Non discriminatory, esp accessible to the most vulnerable, accounting for gender based needs

  • Of good quality ‘scientifically and medically appropriate’

  • Culturally acceptable and ethically sound

  • Physically accessible to all

  • Affordable and reachable by those who are geographically, legally or socially marginalized.

  • Employing and training former and current drug users as peer/social educators and professionals and accepted as an essential component to delivering quality drug services in recognition of their experience and specialist insight into drug issues.

  • User friendly: Physicians and health care professionals are appropriately trained to treat and care for drug users and prescribe and monitor ARTs.

  1. The needs of HIV positive women who use drugs are effectively prioritized

Not enough has been done to address the poverty, subordination, violence and human rights abuses that drive the HIV epidemic among women who use drugs and compound its impact upon them. Today with the rates of HIV increasing faster for women, ignorance within societal attitudes has ensured that positive women who use drugs often become vessels for a great deal of society’s fears and judgments. The stigma that surrounds women drug users and HIV often has its roots in old ideas of promiscuity, used women, diseased, sick women, and infectious mothers. This is often closely associated with drug treatment services being denied outright to women in some countries while many other nations maintain legal or cultural barriers to women accessing the care, support and treatment they need.

We demand that the needs of HIV positive women who use drugs be given the urgent political attention it requires and is prioritized as an issue due to the alarming human rights violations and vast global inequalities in health and social care faced by positive women who use drugs or need access to drug/alcohol services. We call for the design, development, implementation and expansion of women specific drug services – run by women for women. Such services must take into account a woman’s role in her community and family, and appropriate consideration given to a safe and supportive environment for both herself and her children when necessary.

  1. The need to broaden and develop comprehensive and inclusive services that consider the changes in modalities in current drug using behaviors and drug culture.

The unanimous 2001 UN General assembly Declaration on HIV/AIDs recognizes the right of people who use drugs to a broad range of HIV/AIDs prevention and treatment services. In 2005 buprenorphine and methadone were added to the list of essential medicines as defined under the WHO Action Programme on Essential Medicines (Geneva 2007 Section 24.5). While clearly a positive step, the field of drug treatment and prevention has been slow to broaden and develop drug services that engage and reflect the diverse and changing modalities of drug use. The current narrow focus on injection drug users is preventing millions of other people who use drugs from accessing HIV prevention, treatment and/or testing and further harm reduction messages. The exclusion of the drug using community in developing and strengthening more innovative and responsive drug services and HR messages that accurately reflect the rapidly changing face of drug use across the globe is neglecting the health and human rights of a large majority of the illicit drug using population.

We urge the UN and its nation states to act now and design, upscale and broaden drug services to include and address the needs of stimulant users and the smokers of illicit drugs (such as crack, methamphetamine, heroin) who are still vulnerable to blood-borne virus infections and those who may be considered ‘recreational drug users’, yet whose drug use can escalate. More often than not such individuals are not exposed to the usual harm reduction messages or knowledge of drug services and support until the harm has occurred.

  1. To make accessible best practice health and harm reduction services within prisons and detention facilities including HIV prevention and treatment

The criminalization of drug use and thus drug users has meant millions of people who use drugs are being incarcerated and detained in prisons and juvenile facilities around the world, often without due process. The levels of people with drug problems constitute in some cases, between 30-70% of prison populations – many with extremely high rates of HIV and Hepatitis C infection. However, most prison systems have no drug treatment facilities, harm reduction information, or services, adequate detox or methadone maintenance treatment. HIV positive drug users are at particular risk of illness, infection and death due to exposure to stigma, violence (sexual or otherwise) unsanitary conditions and lack of access to ARVs and medicines to treat OI’s.

While the use of harm reduction strategies such as condoms and access to sterile injecting equipment is endorsed by WHO (WHO Policy Brief: Reduction of HIV Transmission in Prisons, May 2004), the reality is that the vast majority of world prisons specifically prohibit such measures, preferring to ignore the reality of drug use, sexual behavior and sexual violence. We recommend the urgent adoption of a minimum set of standards and requirements for prisons and detention facilities to support the implementation best practice, quality health and harm reduction procedures for drug users and those infected and affected by HIV and HCV.

Aug 1, 2008

IDPC Alert - August 2008

The International Drug Policy Consortium (IDPC) is a global network of NGOs and professional networks that specialise in issues related to illegal drug production and use. The Consortium aims to promote objective and open debate on the effectiveness, direction and content of drug policies at national and international level, and supports evidence-based policies that are effective in reducing drug-related harm. It disseminates the reports of its member organisations about particular drug-related matters, and offers expert consultancy services to policymakers and officials around the world.



The International Drug Policy Consortium (IDPC) ( is a global network of NGOs and professional networks that specialise in issues related to illegal drug use. It aims to promote objective and open debate on the effectiveness, direction and content of drug policies at national and international level, and supports evidence-based policies that are effective in reducing drug-related harm. In the two years of its existence, the IDPC has established itself as a credible and respected source of policy analysis and advice for many policy makers in national governments and international agencies. We are now looking to build on this foundation to broaden our analytical and advocacy activities. Release ( manages the work of the IDPC and is looking to appoint a committed and highly professional individual to coordinate its activities. The successful candidate will combine a sound administrative and organisational sense, with good advocacy skills, and an ability to operate at a high level of international affairs. This position is London based, however, exceptional candidates based elsewhere will be considered. The salary range is £30-40k.

If you are interested in applying for this post, please email Geni Horwood at for:

1. Information letter

2. Person Specification

3. Job Description

4. IDPC work plan and membership list

Completed applications should be submitted by 5th September 2008. Interviews will be held in London on 25th and 26th September.



IDPC has produced an advocacy guide to describe the UNGASS 10-year review and the key issues within it. As a way of keeping our network informed, we are producing regular "UNGASS News" updates as the process unfolds. This second edition reports on the outcome of the first three intergovernmental working groups, and the "Beyond 2008" Global NGO Forum.


This is the report of Jangkar (the National Action Network for Drug Harm Reduction in Indonesia) and the Open Society Institute. The report is one of the first attempts to assess and depict violation of drug users� human rights in Indonesia. Since the document is the pdf version of a printed bilingual publication in Indonesian and English, the English version should be read from back to front.



TNI has been involved in international drugs policy work since the 1998 UN General Assembly Special Session on Drugs (UNGASS). This report summarises the lessons of 10 years of work in this field, emphasising drug controls that respect human rights: the rights of farmers caught in the illicit economy to a life in dignity; decriminalisation of drug use; and the promotion of harm reduction approaches where they are proven to save lives.




In the new 2008 World Drug Report the UNODC is trying to hide failures behind a bad history lesson. Instead of a clear acknowledgement that the 10-year UNGASS targets have not been met, the WDR decided to go back 100 years into history claiming success in comparison with Chinese opium production and use in the early 20th century.




The priorities of the French Presidency of the EU have been published and the fight against drugs and drug addiction has been expressly included as a constant objective essential to the protection of citizens. The French presidency will facilitate the negotiation of the new EU action plan against drugs for 2009 - 2012 and prepare EU positions and strategy for the CND. There are hopes to coordinate national positions so that Europe can speak with one voice on the international stage and co-operate more effectively with the third world. The profound objective is to be more effective, that is to obtain a real and measurable impact on the drugs situation in member states and to communicate strategies better so that citizens know and understand them. A busy calendar of events has been prepared by the French Presidency to this end.

An unofficial translation of the above documents has been prepared by IDPC:


In partnership with the United Nations Office on Drugs and Crime (UNODC) and led by the Vienna Non Governmental Organisations Committee on Narcotic Drugs 300 NGO delegates, from all regions of the world, met to debate and construct a consensus on policy recommendations and on mechanisms for NGOs and the government to work together. This consensus, in the form of a Declaration and Resolutions, will be tabled at the Commission on Narcotic Drugs and the UNODC as they prepare for the 1998 - 2008 UNGASS review. The Declaration and Resolutions can be found through this link:


"Drugs, Race and Discrimination" is the theme of the upcoming 2008 Release Conference to be held in London on 18th September 2008. This unique event will focus on discrimination faced by drug users around the world. By highlighting the issues confronting people from an already marginalised background whose drug use leaves them open to further prejudice, this conference will tackle some of the most complex and interesting issues in drug policy today. International speakers presenting original material will include: Deborah Small (Break the Chains); Damon Barret (IHRA); Chris Huhne MP and King Downing (ACLU). Tickets are available on a first come first service basis by following the booking link on the conference programme available here:


Paola Barahona, MPH, a Global Health Policy Associate with Physicians for Human Rights, Washington, is reaching out to friends, family, and colleagues and asking them to consider signing the attached petition to the Government of Iran on behalf of Drs. Kamiar Alaei and Arash Alaei, physician brothers who have been working on HIV and drug use in Iran for many years. They have been detained without any charges by Iranian security forces since late June. There is concern that their detainment may be related to their harm reduction work and leadership. The petition calls on the government of Iran to either charge or immediately release them. Please consider signing the petition online at and let Paula know if you would like her to keep you informed of progress in the case by emailing:

Please feel free to pass this alert on to any contacts who may be interested in drug policy issues. If you have received this alert in error, or do not wish to continue receiving our alerts, you can unsubscribe yourself by emailing to


Blog Directory - Blogged